MRCP在微创技术治疗胆囊结石合并胆总管结石中的应用

MRCP combined with minimally invasive surgery for treatment of gallstone accompanied by common bile duct stone

目的评价MRCP在内窥镜联合腹腔镜治疗胆囊结石合并胆总管结石中的应用价值及其微创方式的选择.方法对B型超声检查未发现胆总管结石,但临床高度怀疑的65例胆囊结石病人行MRCP检查,确认胆总管有结石者行EST治疗,术后3～5 d再行LC术;如未发现结石则可先行LC术,再根据术后的随访情况决定是否进一步行ERCP+EST.结果经MRCP检查发现胆总管结石13例,均成功行EST+LC术.未发现结石的52例仅行LC术.其中,除2例术后反复出现胆道感染、黄疸,经ERCP证实胆总管残留结石行EST取石外,其余病例术后随访1月～2年均未发现异常.结论根据MRCP检查结果选择不同的微创方式治疗可疑伴有胆总管结石的胆囊结石病人是安全可行的,可使胆总管无结石的可疑病人避免有创ERCP检查所带来的痛苦,值得推广.

Objective To evaluate the applied value of MRCP and the choice of minimally invasive surgical procedures for treatment of patients with gallstones accompanied by common bile duct stones with laparoscopic cholecystectomy（LC）combined with endoscopic technology. Methods Sixtyfive patients with gallstones and clinically suspected of common bile duct stones which were not found via B-ultrasonography were subjected to MRCP. If there were the stones in the common bile duct, EST treatment was performed, followed by LC 3-5 day later. If the stones were not found, LC was performed firstly. Results Thirteen cases of common bile duct stones were found by MRCP and subjected to EST＋ LC. In 52 cases without stones found, only LC was performed. Among them, only 2 cases were subjected to EST to remove the stones in common bile duct confirmed by ERCP, and the remaining were followed up for one month to two years and no abnormity was found. Conclusion It was safe and feasible to choose the different ways of minimally invasive surgical procedures for treatment of patients with gallstones suspected of common bile duct stones on the basis of the result of MRCP examination.